1447734249 NPI number — MOBILE VASCULAR RESOURCE INC.

Table of content: (NPI 1447734249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447734249 NPI number — MOBILE VASCULAR RESOURCE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE VASCULAR RESOURCE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447734249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 E SOUTH ST # 301A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90805-4549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-470-6884
Provider Business Mailing Address Fax Number:
562-616-6619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7345 TOPANGA CANYON BLVD STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANOGA PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91303-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-470-6884
Provider Business Practice Location Address Fax Number:
888-646-5861
Provider Enumeration Date:
09/18/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
WINIFRED
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
323-434-0434

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)